POLARIS PEDIATRIC THERAPY PLLC

Notice of Privacy Practices

Your child’s health information, and your rights

A guiding star for little voices.

Effective date:  October 2, 2026

Polaris Pediatric Therapy PLLC provides speech-language therapy to children. To care for your child we keep a record of the care we provide. This notice explains, in plain language, how we may use and share that record and the rights you have over it. We are required by law to protect your child’s health information, to give you this notice, and to follow the terms of the notice that is currently in effect.

In this notice, health information means information that identifies your child and relates to their health, their care, or payment for that care. You means the parent or legal guardian who acts for the child, unless the child is old enough under Texas law to act for themselves. If the patient is 18 or older, “you” means the patient, or a guardian or agent with legal authority to act for them.

Section 1: How We May Use and Share Your Child’s Health Information

For the everyday purposes below we do not need your written permission.

Appointment reminders and messages

We may contact you to remind you about an appointment, to reschedule, or to talk about your child’s care. We use the phone numbers and email addresses you gave us, by the methods you chose when you enrolled, and we may leave a voicemail if you said we may. You can change those choices at any time just by telling us. Ordinary email and text messages are not as private as our secure client portal; if you would rather we used a private channel, tell us and we will use the portal or another reasonable method you choose.

Other treatments and services

We may tell you about other treatment options, services, or programs that might help your child.

Family and others involved in your child’s care

We may share information with a family member, relative, or other person you name who is involved in your child’s care or in paying for it, and only what is directly relevant to what they are doing. If you are present, we will give you the chance to object first. If you are not present, or in an emergency, we will use our professional judgment and share only what is in your child’s best interest. In a disaster, we may also share limited information with a relief organization so your family can be told where your child is and how they are. You can tell us not to, unless that would get in the way of responding to the emergency.

Companies that work for us

Some of what we do is supported by companies we hire, such as our electronic health record, our secure phone and messaging service, and billing support. They may need your child’s health information to do their job. Federal law requires us to have a written agreement with each of them that obliges them to protect the information exactly as we do.

When the law requires or allows it

We may use or share your child’s health information without your permission when the law requires or allows it. This includes:

• To report suspected child abuse or neglect, and abuse, neglect, or exploitation of an adult with a disability, as Texas law requires.
• For public health activities, such as preventing or controlling disease or reporting a problem with a product.
• To health oversight agencies, for audits, investigations, inspections and licensing.
• In response to a court order, subpoena, or other lawful process.
• To law enforcement, in the limited situations the law allows.
• To prevent a serious and imminent threat to someone’s health or safety.
• For workers’ compensation claims.
• To coroners, medical examiners, and funeral directors.
• For research, when the law allows it, such as when a research review board has approved the study and decided that individual permission is not needed.
• To organizations that handle organ, eye, or tissue donation and transplantation.
• For specialized government functions, such as military or national security purposes.
• Whenever any other federal, state, or local law requires the disclosure.

If we ever receive records from a federally assisted substance use disorder treatment program, those records, or testimony about what they say, will not be used or shared in any civil, criminal, administrative, or legislative proceeding against the person the records are about, whether that is you or your child, unless there is written consent, or a court order issued after notice and a chance to be heard and accompanied by a subpoena or other legal requirement, as 42 CFR Part 2 requires.

Section 2: Uses That Always Need Your Written Permission

We will not use or share your child’s health information for any purpose that is not described in this notice unless you give us written permission first. We will always ask you first before we:

• use or share the information for marketing purposes;
• sell the information. We do not sell health information;
• share psychotherapy notes, in the unlikely event any were ever created about your child.

Changing your mind

If you give us written permission, you can take it back at any time by telling us in writing, on paper, by email, or through our client portal. That stops any further sharing, but it cannot undo sharing we already did while your permission was in effect.

Section 3: Your Rights

You have the following rights over your child’s health information. To use any of them, contact our Privacy Officer (Section 7).

Get a copy of your child’s record

You can see or get a copy of your child’s health record. We keep it in an electronic health record system. If your child is 17 or younger, a parent (or, where a court has appointed one, a managing conservator or guardian) can get complete access to your child’s electronic health record right away, unless a court order or a state or federal law limits access to all or part of it (Texas Health and Safety Code § 183.006). Ask us and we will give it to you immediately through our secure client portal or another secure method you choose. For other requests, please ask in writing; an email or a request sent through our client portal counts. Texas law requires us to give you the record in electronic form within 15 business days after we receive your written request, unless you agree to accept it in another format (§ 181.102). Viewing the record and portal access are free; we may charge a reasonable, cost-based fee for copies. In limited cases the law lets us deny access; if we do, we will tell you in writing why, and whether you can have that decision reviewed.

Ask us to correct the record

If you believe something in the record is wrong or incomplete, you can ask us in writing to correct it and tell us why. We will respond within 60 days. We may say no, and if we do we will explain why in writing. You may then file a written statement of disagreement, which we will keep with the record.

Ask for private communications

You can ask us to contact you in a particular way or at a particular place: for example, only on one phone number, or only at an address you name. You do not have to tell us why, and we will say yes to any reasonable request.

Ask us to limit what we use or share

You can ask us not to use or share certain information for treatment, payment, or our operations. We are not required to agree, and we will say no if it would affect your child’s care. There is one request we must agree to: if you pay for a service in full, out of your own pocket, you can tell us not to share information about that service with your health plan, and we will not, unless a law requires it.

Get a list of who we shared it with

You can ask for a list of the times we shared your child’s health information in the six years before your request, who we shared it with, and why. The list will not include sharing for treatment, payment or our operations, sharing you authorized, or a few other exceptions the law names. We will give you one list free every twelve months and may charge a reasonable fee for additional ones.

Get a paper copy of this notice

You can ask for a paper copy of this notice at any time, even if you agreed to receive it electronically. We will give you one promptly.

Choose someone to act for you

A person with legal authority to make health care decisions for your child can exercise these rights and make choices about the information: a parent, a managing conservator or court-appointed guardian, or another adult whom Texas law or a parent’s written authorization allows to consent to your child’s care (for example, a relative or caregiver under a Texas authorization agreement). A patient who is 18 or older exercises these rights personally. A court-appointed guardian of the person can also act for an adult patient. So can an agent named in the patient’s medical power of attorney, once a doctor has certified that the patient cannot make their own health care decisions. We will ask to see documentation of that authority.

Be told if there is a breach

If your child’s unsecured health information is ever breached, we will notify you. We will do that without unreasonable delay and no later than 60 days after we discover it.

Complain without fear

You can complain to us or to the federal government if you believe your privacy rights have been violated. We will never retaliate against you for complaining, and it will not affect your child’s care.

Section 4: Children, Parents, and Guardians

Because we treat children, a parent or legal guardian is usually the person who exercises the rights in this notice on the child’s behalf and who receives the information.

There are limits. We may not treat a parent as the child’s representative if a court order or other law says otherwise, if the child lawfully consented to the care themselves under Texas law, or if we reasonably believe that giving the information to that parent could endanger the child. In those situations we follow Texas law and our professional judgment.

If there is a custody order, guardianship, or other court order that affects who may receive your child’s information, please give us a copy so that we can follow it. Where there is no such order, Texas law generally allows either parent access.

Section 5: Our Responsibilities

• We are required by law to keep your child’s health information private and secure.
• We are required to give you this notice, telling you our legal duties and privacy practices, and to follow the terms of the notice that is currently in effect.
• We will let you know promptly if a breach occurs that may have compromised the privacy or security of your child’s information.
• We will not use or share your child’s information for any other reason unless you tell us in writing that we may. If you tell us we may, you can change your mind at any time.
• We keep clinical records for at least seven years after the last date of service or, for a patient who was a child when we served them, at least until the patient turns 21, whichever is later.

Section 6: Changes to This Notice

We can change this notice, and the changes will apply to all the information we hold, including information we already had. The current version always shows its effective date at the top of the first page.

A changed notice will be available from us on request, posted at polarispediatric.com, available in our client portal, and offered to you at your next visit.

Section 7: Questions and Complaints

If you have a question about this notice, want to use one of your rights, or believe your privacy rights have been violated, please start with us. We would much rather hear about it and put it right.

To make a written request, send it to us through our client portal, email us, or call and we will tell you where to send it.

You may also complain to the federal government, and you may do both. A complaint must generally be filed within 180 days of when you knew the problem happened.

U.S. Department of Health and Human Services
Office for Civil Rights
200 Independence Avenue, S.W., Washington, D.C. 20201
1-877-696-6775
www.hhs.gov/hipaa/filing-a-complaint/index.html

In Texas, the Office of the Attorney General also enforces the state medical-records privacy law: texasattorneygeneral.gov.

We will not retaliate against you for filing a complaint.

We will ask you to sign an acknowledgment that you received this notice. Signing it does not mean you agree to anything or give up any right. It only records that we gave the notice to you.

Thank you for trusting us with your child’s care.